Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101242761 | VA |
N | 207Q00000X | Family Doctor | 0116017521 | VA |
NPI | 1003027913 |
---|---|
Provider Name | Robin Olsen |
First Address | Roanoke, VA 24017-4211 |
Second Address | Roanoke, VA 24017-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 11/08/2011 |